Some IVF patients don’t follow doctor’s orders

Doctors recommend women using fertility treatments cut back on certain activities to increase their chances of having children, but a new study suggests they’re not listening.

Although recommendations are based on just a handful of studies in humans, doctors typically tell women to cut back or eliminate exercise, smoking, drinking and herbal supplement use during their in vitro fertilization (IVF) cycle. Some believe cutting back on those habits will increase the chance of a successful pregnancy.

“We said let’s look at what women are actually doing. Are they doing what we’ve been recommending? The answer is no they are not,” said Alice Domar, the study’s lead author and executive director of the Domar Center for Mind and Body Health of Boston IVF in Waltham, Massachusetts.

Domar and her fellow researchers surveyed women going through an IVF cycle at Boston IVF between June 2009 and March 2010.

Overall, the group of 118 women seemed to be leading healthier lives at the time of their fertility treatments compared to the previous five years. However, the women’s lifestyle choices during their cycle surprised Domar.

The researchers asked each woman to complete a daily survey while they were going through their cycle, which lasts about 28 days. The women stopped taking the survey when the cycle stopped.

Of the 111 women that completed the daily surveys, at least nine out of ten exercised once a week even though they were told to cut back.

In addition to the small amount of evidence that exercise can reduce the chance of a woman getting pregnant from IVF, the treatments increase the size of a woman’s ovaries and can cause discomfort.

“Often, if they’re not listening, it will get very uncomfortable if they’re going for a jog,” said Dr. Lynn Westphal from the Stanford School of Medicine, who was not involved with the new study.

About half of the women continued to drink alcohol during their cycle, and three out of four continued to drink caffeinated beverages.

Domar said she was particularly surprised that one out of every ten women took an herbal medication even though the clinic takes a strong stance against the supplements.

Westphal said she thinks most clinics suggest patients not use herbs.

“The problem with those situations is that we don’t always know what’s in these herbal preparations,” said Westphal.

The survey’s results are limited to a small group of women at one clinic, and the authors were not able to link the likelihood of a pregnancy to whether women were following recommendations. Domar said the results are surprising, however, because the treatments are expensive and the women want to get pregnant.

According to Domar, the treatments can cost between $12,000 and $18,000, but are covered by insurance in Massachusetts.

“I think the IVF population tends to be putting so much into this and they’re typically so motivated,” said Westphal. “You’d think that this population would be following the guidelines to a T.”

This is the first prospective assessment of numerous lifestyle habits during an ART cycle. A number of surprising observations were made. Despite physician recommendation against it, some ART patients took herbs while cycling. Patients continue to exercise regularly and drink caffeine daily, and almost half continued to drink alcohol. Lifestyle behavior counseling should be considered for patients pursuing ART.

Domar told Reuters Health that the center’s guidelines are listed on its website, which the women have to log into to access their records. She said she is now encouraging the physicians to ask the women more questions.

“Clearly just having the information on the website isn’t working,” said Domar.

SOURCE: Fertility and Sterility, online January 5, 2011


  Alice D. Domar, Ph.D.,
  Lisa Conboy, Sc.D.,
  Julia Denardo-Roney,
  Kristin L. Rooney, B.A.

    Boston IVF, Waltham, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
    Osher Research Center, Brigham and Woman’s Hospital, Harvard Medical School, Boston, Massachusetts

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